Tom Goom


Latest posts by Tom Goom

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Right Hip Is Clicking

Posted: 28/09/2013 at 16:59

Hi Steven,

Clicking or 'snapping' hips are quite common and often not actually a problem. If there is no pain and you have good movement in the hip then I wouldn't worry too much, especially if it doesn't affect your running.

There are a few reasons for it, most common are the ITB or Psoas tendon. If the clicking is on the outside of the hip then it's more likely to be the ITB if it's in the front of the hip and into the groin then the Psoas tendon is more likely. The theory is that the clicking is the tendon moving over a bony prominence. A less common cause is a structure within the hip joint called the labrum. 

If it persists and causes pain then seek a medical opinion. If not I wouldn't worry too much. Stretching probably won't change it though.

Hope that makes sense!

Tom

Running-Physio.com

Achilles Problems? Stuck and in need of help please!

Posted: 20/09/2013 at 15:59

Hi Steve,

Achilles tendinopathy is often persistent and difficult to treat, however with the right management it can improve. I agree with PSC, calf strength is very important. Recent research now suggests that muscle strength may be one of the key areas in tendinopathy.

So how do you progress? Firstly you need to seek out an experienced physio who can do a thorough assessment and determine if it is Achilles tendinopathy and whether it's insertional (where the tendon attaches to the heel bone) or mid-portion (in the middle of the tendon). This is important as these two different types of tendinopathy have different treatments.

Secondly you need to address factors that contribute to the injury. Your weight may well be an issue and so losing weight is likely to help. Also people often do exercises or use treatments that make things worse, particularly stretching. This may sound odd but I wouldn't stretch your calf muscles as this is unlikely to help in the long term. Stretching mainly effects the tendon rather than the muscle, you want a strong, fairly inflexible tendon that can handle the force involved in running, stretching won't help this.

Crucially you need to improve the muscle and tendon's ability to handle load. This can be achieved by strengthening the 2 calf muscles (gastroc and soleus). For years people have focussed just on 'heel drops' on the edge of the step but more recent research shows that calf strengthening (e.g. simple calf raises) can be very effective if a high load is used. By high load I mean doing single leg calf raises lifting your own body weight plus around 10-20kg extra (held in a backpack).

The problem is this is often painful to do initially so I recommend a graded build up. Start with 'isometrics' on 2 legs. Do a 2 leg calf raise but hold it for 30 seconds. Repeat 4 times and do this twice per day. When this gets easy progress to doing this on 1 leg. Isometrics really help settle pain and start gentle loading.

Next up progress to 10-15 calf raises, this time without a hold. When you can do 3 sets of 15 just on your weaker leg start to add extra weight and gradually build up. This extra weight stimulates the tendon to recover - it doesn't damage it.

Ideally you want to do 2 types of calf raise - straight knee (to target gastroc) and with the knee flexed to around 30 degrees (to target soleus). Do around 3 sets of 15 reps of each exercise every other day and give it time. Tendon's take around 3 months to adapt to loading you need to keep strength work up for at least this length of time. It doesn't take long to do the exercises and it is worth it.

I hope that helps and makes some sense!

Let me know if you have any questions, also if you let me know where you're based I can try and recommend a good physio near you.

good luck

Tom

Running-physio.com

achilles tendonitis

Posted: 22/07/2013 at 20:26

Hi Coey,

I agree with Seren Nos, it's about seeing how the tendon responds to the exercise. See how it feels at the time and look out for any reaction for 24-48 hrs after.

It does depend a bit on how irritable your achilles problem is, where the pain is and how acute it is. If it's a new episode and is easily aggravated then you may need to be careful with the cross trainer. Also if it's an insertional tendinopathy (pain where the tendon inserts into the heel bone) it is more likely to be aggravated than a mid-tendon issue.

Are you seeing someone about this? If you want more info let me know, I have some achilles articles you might find useful.

Tom

Running-Physio.com

Right Hip Pain

Posted: 21/07/2013 at 22:14

To be honest I don't know many clinics near you. I've asked around and this one was recommended http://ambulantphysio.co.uk/category/meet-the-team/page/3/

Apparently Matt Kenyon who works there is very good!

Hope that helps

Tom

Right Hip Pain

Posted: 20/07/2013 at 23:09

Hi Mohammed,

Here's an article I wrote on it, it's quite technical in parts but hopefully you'll find it helpful - http://www.running-physio.com/gluteal-tendinopathy/

Let me know if you have any questions

Tom

Right Hip Pain

Posted: 20/07/2013 at 15:33

Hi,

Your MRI, was it of the hip and pelvis? Did it include the spine as well? This is a complex area with multiple potential causes of pain.

What you describe could be gluteal tendinopathy. We used to call this 'bursitis' of the hip but more recent research shows it's usually the tendon that's the issue. It usually hurths over the outer hip and sometimes down the leg. It's aggravated by lying on that side, crossing your legs, walking, running and climbing hills or stairs. Does that fit your symptoms? If so let me know - I have a detailed article about it I can post for you if you like?

Thanks

Tom

Running-Physio.com

Advice on training programmes for returning to Running after injury

Posted: 20/07/2013 at 15:26

Hi,

It sounds like you've put in some great ground work already doing cross training and building strength - that should help you return with less risk of injury.

In terms of planning your return there are a few key ideas - make the increase in distance or training intensity gradual, use rest days wisely, monitor changes in symptoms, continue your rehab exercises and ask for help from your Physio when needed!

You have managed 2 miles so that would make a good 'baseline' which you can use as a starting point. Initially you could try running this 2-3 times per week leaving at least 1 rest day between runs to allow your tissues time to recover. You can then increase weekly mileage by around 10% per week providing your symptoms are well controlled. I often suggest patients structure their training with 2 shorter runs and 1 longer one (like you might do for marathon training) but that's up to you. It also often helps to step up and step back - increase mileage for 2-3 weeks then have a rest week where you drop back again to recover a bit.

You could try a couch to 10km training plan or something similar but I find generic training plans aren't great for individual needs. They are either too long and slow or too rapid! 

I would also ask your Physio if there are any aspects of training to be careful - for example hill work, speed work or trail running - this helps you plan a return with less risk of aggravation.

I have some detailed articles on return to running I can post if you'd like?

Tom

Running-Physio.com

 

heel bone taping

Posted: 20/07/2013 at 09:41

Hi David,

I'm not 100% sure what you mean with your heel moving...does the base of the heel bone move out and the top tilt in? Does the arch of the foot also flatten? If so the first taping technique on this page can help - http://www.running-physio.com/ankletape/

Having said that tape isn't always strong enough to prevent excess movement and you want to work out why it's moving like it is. I'd recommend seeing a podiatrist for a proper assessment and a more long term solution. They can also rule out things like Tibialis Posterior Tendinopathy which can lead to flattening of the arch of the foot and change in heel position.

Hope that helps!

Tom

Running-Physio.com

Please help upcoming race and injured!

Posted: 19/07/2013 at 21:28

Hi Natalie,

Other than your GP do you see a Physio or anything? Have you been given a diagnosis and management plan for each of these injuries?

If you keep getting injured then you need to work out the cause and address it. People above are right - the classic too much too soon is a common cause on injury. In a recent study ALL of the injured runners increased their mileage in the week before they got injured.

There are other factors too - BMI, previous injury and biomechanics all can potentially have a role as can another key factor - muscle strength. I wonder if maybe you get injured but then don't properly rehab your strength. You return to running again only to pick up another issue.

with your most recent issue the only way to know how likely it is to be ok to race is to see someone and have it properly assessed. Otherwise it's sort of guess work! If you want though I can post some articles on hamstring injuries that might help?

Tom

Running-Physio.com

Calf raises- weight or quantity?

Posted: 19/07/2013 at 20:56

Hi Alex,

I might have missed this bit but what is the injury? 

Adding weight is usually a good idea as long as there is no increase in pain and you can maintain a good technique. Sometimes as you add weight people can't quite manage to lift fully through range so make sure you can still do this.

I agree with people above about asking your Physio. I'm an NHS Physio myself - we don't mind a phone call from a patient to clarify exercises! 

Tom

Running-Physio.com

 

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